Ryan: We don't know how many we will cover or how much it will cost



With the Congressional Budget Office expected to release its official score of his party's proposed legislation to replace the Affordable Care Act, House Speaker Paul Ryan on Sunday tried to get out in front of the agency's expected prediction of widespread losses of health insurance coverage. In an appearance on CBS's Face the Nation Sunday morning, he explained that if millions of people go without health coverage because of the GOP plan, it won't be because of bad policy. It will be because of freedom.

"The one thing I'm certain will happen is CBO will say, 'Well, gosh. Not as many people will get coverage,'" he told host John Dickerson. "You know why? Because this isn't a government mandate. This is not the government that makes you buy what we say you should buy and therefore the government thinks you're all going to buy it."

Related: Is This Why the GOP Is Having Trouble Selling Its Health Care Plan?

Ryan insisted that despite slashing funding for Medicaid and vastly reducing the assistance low-income people receive for paying insurance premiums, that health insurance under the GOP-proposed American Health Care Act, will become more accessible. That's because, he said, the AHCA will increase choice and competition, and thereby lower prices, presumably by at least as much as the many thousands of dollars per year that low-income Americans will lose in subsidies.

In the end, he said, if millions of Americans who now have insurance find themselves without it, it won't be because they can't afford it. It will be because they choose not to have it. "We're not going to make an American do what they don't want to do. You get it if you want it. That's freedom."

Ryan's view is, to say the least, not widely shared by the medical community or advocates for the populations likely to be most affected by the proposed changes to existing law. The AHCA's proposal to replace subsidies linked to income with refundable tax credits linked to age was particularly bothersome to the American Medical Association, which has warned that the credits are too small to cover the costs of health insurance.

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Republican reactions to the American Health Care Act
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Republican reactions to the American Health Care Act
I'm worried about doing it right. I've seen 1 process that produced Obamacare where you vote on Christmas Eve. I do… https://t.co/cHyjYNPuI8
The House leadership plan is Obamacare Lite. It will not pass. Conservarives are not going to take it. #FullRepeal
The House leadership Obamacare Lite plan has many problems. We should be stopping mandates, taxes and entitlements not keeping them.
House Obamacare Lite plan keeps Obamacare taxes for another year
Their plan keeps the Obamacare "Cadillac Tax" forever, which is a tax on the best health insurance.
It keeps individual mandate but makes you pay the insurance companies instead of the government
The American Health Care Act will: ✅ Drive down costs ✅ Encourage competition ✅ Empower individuals and families https://t.co/8DFIsPEWUI
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"It is important...that the amount of credits available to individuals be sufficient to enable one to afford quality coverage. We believe that credits should be inversely related to an individual's income," the association's executive vice president, Dr. James Madara, wrote in a letter to Congress. "This structure provides the greatest chance that those of the least means are able to purchase coverage. We believe credits inversely related to income, rather than age as proposed in the committee's legislation, not only result in greater numbers of people insured but are a more efficient use of taxpayer resources."

Related: OMB Director Mulvaney Blowing Smoke on Health Law's Impact

The elder advocacy group AARP warned that the tax credit system would end up costing low-income seniors not yet eligible for Medicare up to $8,400 a year in increased costs and that a proposal to cut and cap Medicaid funding would effectively eliminate the last resort for many poor people seeking health coverage.

"In providing a fixed amount of federal funding per person, this approach to financing would likely result in overwhelming cost shifts to states, state taxpayers, and families unable to shoulder the costs of care without sufficient federal support. This would result in cuts to program eligibility, services, or both – ultimately harming some of our nation's most vulnerable citizens," the group senior vice president for public affairs, Joyce A. Rogers, said in a letter to Congress.

On Sunday, Dickerson asked Ryan about all the opposition the plan has been facing, including from Republican senators who have called on the House to slow down rather than trying to push through a bill that, currently, doesn't have enough support to pass in the Senate.

The Speaker said that waiting isn't an option, claiming that the current system is in imminent danger of collapse. Also, freedom.

Related: Is the Republican Health Care Bill Headed for a Do-Over?

"This is historic, and it's significant," he said. "And if we don't act, the system's going to collapse. And the beautiful thing about this plan that we're proposing, it's more freedom. It's more choices. It's more markets. It's lower prices, which gets us better access."

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Paul Ryan through his career
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Paul Ryan through his career
Speaker of the House Denis Hastert (L) administers the oath of office to Rep. Paul Ryan (R) of Wisconsin as his family looks on January 6, 1999 at the start of the 106th Congress. The oath is a recreation as the formal oath is administered to the entire congress as a body on the floor of the House. (photo by Rex Banner)
UNITED STATES - DECEMBER 12: Rep. Paul Ryan, R-Wis., speaks at a news conference in which House Republican leaders called for Permanent Tax Relief. (Photo By Tom Williams/Roll Call/Getty Images)
KRT US NEWS STORY SLUGGED: SOCIALSECURITY-DISCUSSION KRT PHOTOGRAPH BY GEORGE BRIDGES/KRT (April 14) Conversation on Social Security between Rep. Paul Ryan (R-WI), shown, and William Novelli, head of AARP, April 5, 2005 (lde) 2005 (Photo by George Bridges/MCT/MCT via Getty Images)
UNITED STATES - JULY 22: MEDICARE BRIEFING--Rep. Paul Ryan, R-Wisc., speaks at a Cato Institute briefing on Medicare reform in the Rayburn House Office Building. Tom Miller, director of Health Policy Studies at Cato, looks on. (Photo by Scott J. Ferrell/Congressional Quarterly/Getty Images)
WASHINGTON - SEPTEMBER 24: Rep. Paul Ryan (R-WI) questions Peter Orszag, director of the Congressional Budget Office, during a hearing on Capitol Hill about the impact of recent market turmoil on the federal budget on September 24, 2008 in Washington, DC. Orszag reported that while the impact is currently unknown, it is likely to be substantially less than $700 billion. (Photo by Brendan Hoffman/Getty Images)
WASHINGTON - APRIL 27: House Budget Committee ranking member Rep. Paul Ryan (R-WI) (R) delivers an opening statement during a conference committee meeting with Senate Budget Committee Chairman Kent Conrad (D-ND) (L) and House Budget Committee Chairman John Spratt (D-SC) in the U.S. Capitol April 27, 2009 in Washington, DC. House and Senate lawmakers have already struck a tentative deal on the FY2010 budget resolution and they hope to file a conference report after today's meeting. (Photo by Chip Somodevilla/Getty Images)
WASHINGTON - MARCH 19: (L-R) U.S. House Minority Whip Rep. Eric Cantor (R-VA), Rep. Dave Camp (R-MI) and Rep. Paul Ryan (R-WI) listen during a news conference on the health care legislation March 19, 2010 on Capitol Hill in Washington, DC. The House will vote on the Health Care Reform Legislation on Sunday, March 21. (Photo by Alex Wong/Getty Images)
Representative Paul Ryan, a Republican from Wisconsin and chairman of the House Budget Committee, speaks during a news conference at the U.S. Capitol in Washington, D.C., U.S., on Tuesday, April 5, 2011. U.S. House Republicans today unveiled a plan to overhaul the federal budget and slash the deficit in coming years by about three-quarters, with a $6-trillion cut in spending and 25 percent cap on tax rates. Photographer: Joshua Roberts/Bloomberg via Getty Images
MEET THE PRESS -- Pictured: Rep. Paul Ryan (R-WI) left, and moderator David Gregory, right, appear on 'Meet the Press' in Washington, D.C., Sunday, April 10, 2011. (Photo by William B. Plowman/NBC/NBCU Photo Bank via Getty Images)
MILWAUKEE, WI - APRIL 01: Republican Presidential candidate, former Massachusetts Gov. Mitt Romney (R) jokes with U.S. Rep Paul Ryan (C) (R-WI) during a pancake brunch at Bluemound Gardens on April 1, 2012 in Milwaukee, Wisconsin. With less than a week before the Wisconsin primary, Mitt Romney continues to campaign through the state. (Photo by Justin Sullivan/Getty Images)
WASHINGTON, DC - APRIL 26: House Budget Chairman Rep. Paul Ryan (R-WI) is introduced before speaking about 'America's Enduring Promise,' and the federal budget, in a speech at Georgetown University April 26, 2012 in Washington, DC. During his speech, Ryan said that his proposed budget confronts the nation's growing $15 trillion debt before it impacts future generations of Americans. (Photo by Win McNamee/Getty Images)
NORFOLK, VA - AUGUST 11: Republican presidential candidate, former Massachusetts Gov. Mitt Romney (L) jokes with Rep. Paul Ryan (R-WI) (R) after announcing him as the 'next PRESIDENT of the United States' during an event announcing him as his running mate in front of the USS Wisconsin August 11, 2012 in Norfolk, Virginia. Ryan, a seven term congressman, is Chairman of the House Budget Committee and provides a strong contrast to the Obama administration on fiscal policy. (Photo by Win McNamee/Getty Images)
UNITED STATES - SEPTEMBER 14: Rep. Paul Ryan, R-Wis., Vice Presidential candidate, waves to the crowd after addressing the Values Voter Summit at the Omni Shoreham Hotel in Woodley Park. Photo By Tom Williams/CQ Roll Call)
NEWPORT NEWS, VA - SEPTEMBER 18: Republican vice presidential candidate, U.S. Rep. Paul Ryan (R-WI), pauses as he speaks during a campaign rally at Christopher Newport University September 18, 2012 in Newport News, Virginia. Ryan continued to campaign for the upcoming presidential election. (Photo by Alex Wong/Getty Images)
MIAMI, FL - SEPTEMBER 22: Republican vice presidential candidate, U.S. Rep. Paul Ryan (R-WI) hugs waitress, Lourdes Alcerro, during a campaign stop at Versailles restaurant in the Little Havana neighborhood on September 22, 2012 in Miami, Florida. Ryan continues to campaign for votes across the country. (Photo by Joe Raedle/Getty Images)
Republican presidential candidate Mitt Romney (R) and running-mate Paul Ryan share a laugh as they are introduced at a campaign rally September 25, 2012 at Dayton International Airport in Vandalia, Ohio. AFP PHOTO/Mandel NGAN (Photo credit should read MANDEL NGAN/AFP/GettyImages)
Representative Paul Ryan, a Republican from Wisconsin, arrives at a news conference on Capitol Hill in Washington, D.C., U.S., on Tuesday, Oct. 20, 2015. Ryan said he'd be willing to run for speaker of the U.S. House if Republicans unify behind him now, end leadership crises and let him continue spending time with his family. Photographer: Andrew Harrer/Bloomberg via Getty Images
Representative Paul Ryan, a Republican from Wisconsin and chairman of the House Ways and Means Committee, center right, walks down the steps of the U.S. Capitol building following a vote in Washington, D.C., U.S., on Friday, Oct. 9, 2015. Ryan is under heavy pressure from fellow Republicans to run for U.S. House speaker after a hard-line faction forced Speaker John Boehner to resign and his top lieutenant to drop out of the race. Photographer: Andrew Harrer/Bloomberg via Getty Images
Representative Paul Ryan, a Republican from Wisconsin, walks to a meeting in the basement of the U.S. Capitol in Washington, D.C., U.S., on Tuesday, Oct. 20, 2015. Ryan is set to meet with a group of House conservatives Tuesday as he weighs a potential run to replace Speaker John Boehner under pressure from fellow Republicans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Representative Paul Ryan, a Republican from Wisconsin and chairman of the House Ways and Means Committee, center, talks to the media after walking out of the U.S. Capitol building following a vote in Washington, D.C., U.S., on Friday, Oct. 9, 2015. Ryan is under heavy pressure from fellow Republicans to run for U.S. House speaker after a hard-line faction forced Speaker John Boehner to resign and his top lieutenant to drop out of the race. Photographer: Andrew Harrer/Bloomberg via Getty Images
UNITED STATES - OCTOBER 20 - Rep. Paul Ryan, R-Wis., speaks at a news conference following a House Republican meeting, on Capitol Hill in Washington, Tuesday, Oct. 20, 2015. Ryan is stating that he will run for speaker only if he receives enough GOP support by the end of the week. (Photo By Al Drago/CQ Roll Call)
US Speaker of the House Paul Ryan, Republican of Wisconsin, awaits the arrival of Israeli President Reuven Rivlin for a meeting at the US Capitol in Washington, DC, December 10, 2015. AFP PHOTO / SAUL LOEB / AFP / SAUL LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
WASHINGTON, DC - DECEMBER 10: House Speaker Paul Ryan (R-WI) holds his weekly press briefing on Capitol Hill on December 10, 2015 in Washington, D.C. Paul Ryan spoke on topics including Donald Trump and the spending bill. (Photo by Allison Shelley/Getty Images)
WASHINGTON, DC - DECEMBER 15: Speaker of the House Paul Ryan, (R-WI) speaks during a Politico interview at the Grand Hyatt on December 15, 2015 in Washington DC. Ryan was interviewed by Politico's Chief White House Correspondent Mike Allen during a Politico Playbook Breakfast. (Photo by Mark Wilson/Getty Images)
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Returning to the pending CBO report on the AHCA, Dickerson asked again about the number of people who could be expected to lose coverage under the bill. Ryan refused to accept the premise of the question.

"I can't answer that question," he said. "It's up to people. Here's the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country."

The next move in this game will come Monday or Tuesday, with the CBO's estimate of how many Americans would be forced to exercise their "freedom" to go without health insurance under AHCA.

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